Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia.
This review examines the perioperative safety implications of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a drug class increasingly used for type 2 diabetes and obesity management. The authors focus on the mechanism by which GLP-1 RAs delay gastric emptying and how this pharmacological effect may elevate the risk of pulmonary aspiration during general anesthesia—specifically at induction and emergence—even when patients have followed standard preoperative fasting protocols. The review distinguishes between short-acting GLP-1 RAs, which reportedly cause more pronounced gastric emptying delays, and long-acting agents, whose residual effects may vary by dose and duration of treatment. The authors also survey updated guidance issued by international anesthesia societies in response to these concerns. Key limitations acknowledged include the overall scarcity and inconsistency of available clinical evidence. The review concludes by advocating for individualized, interdisciplinary perioperative management involving collaboration between endocrinologists and anesthesiologists. As a narrative review, it does not generate new primary data, and the conclusions are constrained by the quality of the underlying literature.
Why this grade: This is a narrative review synthesizing existing literature without generating new primary data; its evidence grade reflects the review study design rather than direct experimental findings.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for managing type 2 diabetes mellitus and obesity because of their glucose-lowering, weight-reducing, and cardiovascular benefits. However, their potential to delay gastric emptying has raised growing concern in perioperative care, particularly regarding the risk of pulmonary aspiration during general anesthesia. Recent studies have shown that patients treated with GLP-1 RAs may retain considerable gastric contents even after standard preoperative fasting, thereby increasing the likelihood of regurgitation and aspiration during anesthesia induction or emergence. Short-acting GLP-1 RAs cause more pronounced delays in gastric emptying, whereas long-acting agents may exert residual effects depending on dose and treatment duration. Several international anesthesia societies have issued updated guidance to mitigate these risks, yet available evidence remains limited and sometimes inconsistent. This review summarizes the pharmacological mechanisms and clinical implications of GLP-1 RA-induced delayed gastric emptying, evaluates current literature on perioperative aspiration risk, and emphasizes the importance of interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management.
Educational summary of published research — not medical advice. License: cc by-nc. Full text is shown only where licensing permits.